The Digital Clinician
SUMMARY:
The traditional paradigm of clinical history, examination, differential diagnosis and treatment has been changed with the rapid expansion of digital healthcare.
The full impact of these advances face new challenges and opportunities.
Clinicians must be active participants in this journey.
REVIEW
The future of care delivery will look dramatically different than it does today.
This will require a fundamental shift in skills from data knowledge acquisition to interpretation of digital data sources and effective communication.
Clinicians believe digital skills will be needed
Extending current care practices into the digital space is not an easy integration.
It will not be simply downloading an app.
The core barriers include:
Digital health literacy
Patient & clinician willingness to adopt digital tools
Provider time and training
Workflow issues
Consistent engagement
Privacy
Lack of confidence in the technology
The world of digital data offers active or passive data collection related to a patient’s health which can:
Detect the development of acute illness earlier
Track progress of disease state
Offer patient centered interventions remotely
Currently the major enthusiasm for these developments must be tempered with caution as clinical validation remains an important and often missing component.
Actual disease detection may be low.
Of the 419,297 smartwatch participants, an irregular heartbeat was only identified in 2,161 (0.52%), with an even lower incidence of atrial fibrillation detection. (Perez et al NEJM 2019;381:1909)
Current tools suffer from false positive and false negative accuracy. (Racine et al Canadian Journal of Cardiology 2022;38:1709).
With improvements in interfaces, development of novel algorithms and artificial intelligence, the relationship between this data and clinical outcomes will become better understood.
Who will be responsible for monitoring these data?
Who will explain the findings?
Do clinicians currently have the time to do these functions effectively?
The cost and practicality of this future world will also be a consideration
The digital clinician of the future will need to address:
Re-Design of Clinical Visits:
Ensure data captured outside the care visit is always reviewed, before and during the visit.
Salient data is used for clinical consideration and shared decision making.
A new care plan is developed, including technologic considerations (specific application or new device based on practical skills and disease) to monitor progress.
Follow up of the new plan in between in-person visits.
Rethink Clinical Workflows:
Integrate digital tools as seamlessly and as simply as possible.
Providing additional support to clinician and patient to avoid implementation failure will be a major consideration
.Additional Clinician Training:
Fully understanding the application.
How to use the application.
Knowling when to recommend the application during the visit.
Distilling Patient Data Collected into Clinically Meaningful Summaries:
The constant flow of patient data can make setting clinically relevant boundaries unclear.
Establishing clinical best practices for appropriate application use.
Equal Access to Digital Care:
Attention to digital literacy.
Adequate wireless connectivity.
Digital tools available in different languages.
Accessibility to those with disabilities.
CONCLUSIONS:
Digital healthcare offers a unique set of challenges and opportunities to improve treatment outcomes.
The Digital Clinician has a key role to play in the development of the new delivery of care within healthcare systems.
The Digital Clinician will need a new approach with new skills to integrate the digital data sources into care plans as it is not simply downloading an app.